Pallidal deep brain stimulation: an effective treatment in Chinese patients with tardive dystonia

Abstract

A B S T R A C TTardive dystonia is an iatrogenic complication of dopamine receptor antagonist medication such as first-generation antipsychotics. It occurs in up to 2% of patients and only 10% recover after stopping medication. Deep brain stimulation for primary dystonia has proven to be effective and its application for secondary dystonias is gaining acceptance. We report our experience in treating three ethnic Chinese schizophrenia patients with severe medically refractory tardive dystonia by globus pallidus internus deep brain stimulation. Preoperatively, all required assistance with essential activities of daily living and two were bed-bound. The mean Burke-Fahn-Marsden Dystonia Rating Scale score was 61 (range, 44-80) and mean Global Dystonia Rating Scale score was 47 (range, 40-52). No procedure-related complications were encountered. By 3 months all could return to unassisted living and walk with support with a mean of 77% and 66% improvement in the Burke-Fahn-Marsden Dystonia Rating Scale and Global Dystonia Rating Scale scores, respectively. Quality-of-life assessment performed for two patients using the EuroQol-5 dimensions visual analogue scale showed a mean improvement of 86% at 3 months. On clinical follow-up, the effect has proven to be effective for secondary dystonias such as TD. [4][5][6][7] We report our experience with using DBS for treating three young ethnic Chinese patients with severe TD refractory to pharmacological management. Case reports Clinical assessmentThree paranoid schizophrenia patients were referred by psychiatrists for TD satisfying the proposed diagnostic criteria by Adityanjee et al. 2 All three patients were managed by the

Tardive dyskinesia in Asia— current clinical practice and the role of neurologists in the care pathway

“…A study from Japan by Koyama H et al showed a significant improvement in mean Burke–Fahn–Marsden Dystonia Rating Scale (BFMDRS) scores at 1 month postoperatively of 75% with long-term improvement in BFMDRS scores of 78.0% ( 145 ). Another case report showed that pallidal DBS was an effective treatment for Chinese patients with tardive dystonia with an improvement in BFMDRS scores of 77% and in Global Dystonia Rating Scale scores of 66% ( 146 ). Although the effectiveness of DBS in TD and tardive dystonia is promising, further studies with DBS in other tardive syndromes are needed in Asian patients.…”

Deep Brain Stimulation in the Treatment of Tardive Dyskinesia

“…small groups of 2-4 people [44,65,67,69,77,86,87] or slightly larger groups [40,43,74,79,81,88,89] when 19 patients were the largest cohort [37].…”

Quality of life outcomes after deep brain stimulation in dystonia: A systematic review

“…T. Tsuboi, et al Parkinsonism and Related Disorders 70 (2020) [82][83][84][85][86][87][88][89][90][91][92][93] Some other studies reported the long-term efficacy of GPi or STN DBS on tardive dystonia with variable assessment scales as summarized in Table 3 [60][61][62][63]. One study found that, after GPi DBS, HRQoL domains according to SF-36 (role physical, and social functioning, and PCS) significantly improved at a mean follow-up of 3.4 years [62].…”